IEPs and Effective Program Planning for Students with TBI · 2019-04-27 · IEPs and Effective Program Planning for Students with Traumatic Brain Injury Patricia Sublette, PhD Deborah

August  7,  2011  

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IEPs and Effective Program

Planning for Students with

Traumatic Brain Injury

Patricia Sublette, PhD Deborah Ettel, PhD

Center on Brain Injury Research and Training

Pennsylvania Low Incidence Institute – High Expectations for Achievement

August 7, 2011

Outline

  Introductions

  Video clip

  3 things that are different about TBI

  What is similar about TBI?

  About Matt

  Overview of Tier I, II and III Interventions

  What is different about eligibility for TBI?

  IEP writing for TBI

  Intervention ideas

  Sample IEP goals

  Program planning

  Q & A

Video clip 3 things that are different about TBI, compared to other disabilities

PA Educational Definition of TBI

  The Individuals with Disabilities Education Act (IDEA), Public Law 101-476, includes traumatic brain injury (TBI) as a distinct disability category. TBI is defined as an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. The term applies to open and closed head injuries resulting in impairments in one or more areas such as:

  Cognition, language, memory, attention, reasoning, abstract thinking judgment, problem-solving, sensory, perceptual motor abilities, psychosocial behavior, physical functions, information processing, speech

What is the same about TBI, compared to other disabilities?

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Matt Overview of TIER 1, 2 and 3 Levels of Intervention

Core

Targeted

Intensive

Matt

Matt – like many students with a new TBI – started at Tier III and worked backwards in interventions.

Year 1

 Full time assistant

 Monitored in all classes

 Unable to organize

 Inappropriate choices  Porn, touching

 Data was easy to take

Year 2

 Worked hard to “get rid” of assistant

 Depressed   Yet smiled and laughed until explosion

 Hated SPED Teacher  Refused classroom

Year 3

 Current “arrangement with SPED teacher” and plans for future

 Still laughs in response to pain and discomfort

 Church camp leader   Plans to attend a small college in music

 Relies on many overt cues from others to perform socially in school

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So what’s different about TBI?

  May start on Tier III

  Problems tend to be more exaggerated

  More extreme discrepancies among skills

  More uneven and unpredictable progress

  The condition could improve to pre-injury state

  Previously learned material may be gone or need to be relearned

TBI is likely to cause problems with...

 Impulse control/Judgment

 Organization

 Skill integration

 Generalization

 Abstract reasoning

 Social judgment

Eligibility

Document that student has a disabling condition:

 Evaluate areas not typically targeted   Judgment, planning, etc.

 What do we know about his pre-injury performance?

 Pre vs. Post-injury performance is the basis for documenting TBI as the cause of disability

 Medical documentation

Impact of TBI on current performance

 Is there a need for specially designed instruction?

 Don’t forget adaptive behavior!

The student meets all three of the following criteria:

1.  The student has an acquired injury to the brain, caused by an external physical force

2.  The student’s condition is permanent or expected to last for more than 60 calendar days

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3.  The student’s injury results in an impairment of one or more of the following areas:

 Communication;

 Behavior;

 Cognition, memory, attention, abstract thinking, judgment, problem solving, reasoning, and/or information processing;

 Sensory, perceptual, motor and/or physical abilities

Why not just identify with LD, OHI, VI, etc….?  Other eligibilities have less

variability over time and setting

 Knowledge of TBI can become lost over time, but effects are not lost   Need for higher functioning may occur

after student is no longer eligible under another eligibility

  Consequences of TBI may not be recognized as disabilities (may be considered idiosyncratic quirks)

The Right Category Matters!

  Increases understanding

  Instructional strategies and behavior management strategies differ

  Increased awareness of TBI and need for resources

 Dollars flow through special education eligibilities via formulas that are established by the state

Writing the IEP

What is in the Individual Education Program?

 Agreement between local school district and the parents of a student who is eligible for SPED services

 Summarizes present levels of academic and functional performance of a student

 Has annual goals

  Indicates the amount of time a student will attend regular classes, be away from non-disabled students, etc.

 Accommodations the student may need to participate in classes and statewide assessments

 Plans for transition services (for students 16 and older)

 Dates and location of services to be offered, related services that will be offered to the student and supports for school personnel

IEP Process: Making it Work

 Gather information from:  Parents   Teachers   Interview the student !!!

 Observe the student

 Don’t forget adaptive behavior!

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Make the IEP Student Centered

 Find out student’s:  Goals Hopes Dreams  Obstacles  Strategies  Action Plan

Running the Meeting

 Facilitate a problem solving process:   Letting FORMS run the meeting...   Takes the focus off the student   Leads to “SPED speak”

 Keep meeting to 1 hour or less

 Set expectation of participation

 Make it visual (big helps too)   Use charts & markers

Overcoming Obstacles

 Start with student’s input or dreams

 Pick one or two obstacles to overcome

 Use an action plan to address the obstacles   The targets for the action plan become

the goals for the IEP

Facilitator Skills

 Find points of agreement

 Restate or refrain

 Paraphrasing

 Agree to disagree – but find points of commonality so you can move forward  Refine and define

Who should be at an IEP meeting for a student with TBI?

  Student!

  Parent/guardian

  Case manager (usually the special education teacher)

  Classroom teacher

  District representative

  Person knowledgeable about TBI

  Person able to interpret evaluation data

Professionals to Include

  School psychologist

  Physical therapist

  Occupational therapist

  Speech pathologist

  Person with expertise in TBI (consultant)

  Vision specialist

  Deaf/hard of hearing specialist

  School nurse

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First IEP Meeting!

 Between 4-6 IEP meetings a year, due to changing needs  Depending on the time since the injury

 Schedule the next 2 meetings at this time

Present Levels of Academic Achievement & Functional Performance

  Include information on the student’s academic, social, behavioral, sensory, communication, mobility, and medical issues, such as headaches or fatigue.

 Adaptive ability results

 Focus on student strengths and effective strategies

 Describe what helps the student learn

 What limits or interferes with the student’s learning

  Include objective data from evaluations

  Indicate how the disability affects ability to progress in the general education curriculum

Program needs for students with TBI

 Students with TBI tend to have needs that cross several subject areas   IEP goals must address issues across

several classes or settings   Teach same skills in multiple settings

Behavior issues to consider in IEP

 Students with TBI sometimes have:   low frustration tolerance   difficulty understanding social cues   fatigue   impulsivity   confabulation

  Identification of pre-injury status is needed!

 FBA is needed

Behavior

 Tantrums

 Outbursts

 Inappropriate language

 Violence

 Withdrawal

Behavior interventions to consider

 Coaching to assist with misperceptions

 Give clear guidelines for tasks  Help student determine own goals for:   When to start   What to do   How much to do   What finished looks like   What to do next

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Social-Emotional Issues to Consider in IEP Planning

 Consider the student’s ability to   Link their behavior to consequences  Understand their new set of abilities

 The impact of depression

 Social isolation

Physical issues to consider in IEP Planning

  Feeding

 Safety

 Mobility

 Seizure

  Fatigue

  Latex protocol

  Adaptive devices

 Medication management

  Fire drill procedure

Protocol/training

Cognitive Issues to Consider in IEP Planning

 Students may respond to cognitive challenges with behavior outbursts or withdrawal

 Students may insist on using old strategies that were successful prior to the accident  Another reason for multiple IEP

meetings

More Cognitive Issues

  Orientation to place and time reduced

  Overload/breakdown of comprehension   Especially when fatigued   Results in irritability, tears, tantrums

  Initiation/motivation

  Perseveration

  Reduced rate of   processing   performance

Memory

 Long term

 Short term

 Prospective

 Working memory

Memory Interventions

 AT device  Planner  PDA  Cell phone alarm  Notes  Visual reminders   Picture schedules

 Coaching/consultation

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Concrete Thinking

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Difficulty with abstraction, synthesis, inference, etc.

Concrete Thinking Strategies

 Prompts and reminders  Coaching

 Structured teaching

 Social  Goal Plan Do Review   Comic strip conversations adapted for

review   Friendship groups (facilitated)

Slow Processing Speed Processing Speed Strategies

 Give more time to complete tasks  Continue to request school and

household tasks

 In school  Note-taker  Books on MP3 or CD   Audio-assisted reading   Assistive technology programs to help with

production of written language

Planning Challenges

 Impacts  Behavior  Goal setting  Ability to complete tasks   Homework   Getting to places on time

 Daily living skills!

Planning Interventions

  State the obvious...   it may not be as clear

to the student

  Routines

  Scripts

  Picture schedules   Calendar to plan

long-range projects with student   Coach through every

step

  Checklists or cue cards   steps for completing a

task

  Goal-setting and planning sheets   organize the checklists

into a small notebook for easy reference

  With number of steps in a task

  Number of items to be completed

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Difficulty Initiating (starting)

 Conversations  Appropriate  Social nuances

 Tasks   Jobs  Getting out of bed

Initiation Interventions

 Goal

 Plan

 Do

 Review

 Coach the student to do tasks appropriately in multiple settings

Communication Issues to Consider in IEP Planning

 Social use of language   turn taking in

conversation   not interrupting others   tracking a conversation   other practical language

skills   as well as speech

production

Include...

Regular or Extended Assessment?

  Consider the student’s ability to   work without fatigue   manage pain   use memory

  Process information   how quickly the student thinks, speaks and

performs tasks

  Physically manage materials

  Use vision

  Structure their thoughts around problems

Assistive Technology

 Because of difficulties transferring learning from one setting to another and potential memory deficits, students with TBI may need SDI to learn to use assistive technology devices in multiple settings.

Measurable Annual Goals

State goals as an increase in positive behaviors, rather than the elimination of a negative behavior

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Goals that go beyond specific academic areas

 Keep goals functionally oriented and outcome-based

 Base goals on the student strengths paired with student need

 Look for changes in any of the areas

  IEP may need to be rewritten every 2-4 months to meet changing needs of student

Remember:

Sample IEP Goals

  Communication   Given a topic, Steven will take 4 turns in a

conversation before changing the topic 3 out of 4 trials across 3 settings: in speech therapy, in the classroom and in the hallway.

  Sam will choose an activity and show a picture of that activity to another student as an invitation to play.

  Behavior   Jenny will remove herself from a confrontation

with a classmate by going to the counselor’s office and choosing an activity from her cool down box – 2 out of 3 opportunities during lunch/recess.

Sample IEP Goals

  Memory   After learning 4 memory techniques, Sarah will

chose one and use it to recall the names of 5 friends 3 times each week.

  To be better prepared for homework, Sam will record class assignments in a planner and review it at the end of the day with Mr. Green.

  Attention   Shelly will self-advocate by requesting the

elimination of sources of distraction during instruction in an appropriate way 4 out of 5 times two consecutive days.

Sample Goals

 Abstract thinking  Given a form to complete, Suzy will

make a reasonable inference about a paragraph she has read 4 out of 5 times for 6 weeks in a row.

 After listening to a paragraph from different content areas, Ginger will accurately predict what might happen next 3 out of 5 times for 5 consecutive days.

Sample Goals

 Judgment  With guidance Mary will use a matrix of

choices to determine the best option for herself when deciding between 3 possibilities.

 Mary will meet with Ms. Stand to discuss consequences of 1 choice she plans to make prior to lunch 3/5 days each week.

Even More Sample Goals

  Problem solving   Sandy will generate 4 solutions to a problem

she has had at recess and choose a solution to try the next recess 3 out of 5 days each week.

  After choosing a problem, Sid will meet with his mentor to determine ways to solve the problem.

  Reasoning   Bentley will create a shopping list using the

amount of money he has budgeted.   With guidance, Bentley will use a shopping list

he has created to purchase needed items for the week at the store.

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More and More Sample Goals

 Perceptual Motor   Taylor will use visual cues to find her

way from class to class independently 4 out of 5 classes for 3 consecutive days.

  Taylor will be accompanied by an assistant between classes (accommodation).

The never ending Sample Goals

 Information processing  After listening to a story, Sandy will

retell with pauses of less than 30 seconds, 3 times each week.

 Sensory  When crossing the street with

assistance, Steve will turn his head to use his right eye to scan the left side of his body to keep his body safe.

The FINAL Sample Goals

 Physical Abilities  Given a tangible cue, Dakota will

navigate the hall independently in his wheelchair to the destination indicated by the cue.

 Karla will spend 30 minutes each day in her stander.

Program Planning

Placement

 Students regain skills best with   familiarity of the classroom   known teachers   known peers   routines   behavioral and cognitive supports needed

 For most children, rehabilitation takes place in school

Adapted from Ylvisaker. Traumatic Brain Injury Rehabilitation: Children and Adolescents. 2nd ed. Appendix 17-1

Cautions about Placement

  Home tutoring   Behavioral problems may increase because

  Family members not trained to handle   The student may fall farther behind academically   Student may become anxious about returning to

school

  Temporary placement in a special education class can provide   Inappropriate modeling for students who are

trying to regain social skills   Emotional difficulty for student and family

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Program planning

 Keep with peers as much as possible

 Why not SPED classroom?

 Include student

 Give student control over as much as possible

SDI and TBI

 cognition

  language

 memory

 attention

  reasoning

 abstract thinking

  judgment

 planning

 problem-solving

 sensory

 perceptual motor abilities

 psychosocial behavior

 physical functions

  information processing

 speech

New Learning is HARD

 Learning requires motivation and repetition

 Create motivation by including student

+

Unintended Side Effects of Poorly Planned Interventions

+ Q & A Plus, Evaluation!